This answer is for informational purposes only, and is not intended
to diagnose or replace medical advice from a licensed physician. None
of what is posted is to be considered a diagnosis, but considered to
be simply possibilities.
I urge you to be seen by your physician immediately. While something
as simple as stress could be causing these symptoms, I would want
serious possibilities to be ruled out.
Here are some descriptions of the upper facial muscles:
Outer Frontalis muscle
This site is non-copy-able. See the bottom of Page 10 ? 7th Facial Nerve
If you are under stress, you might try this exercise:
?Face: Tense the muscles of the forehead and eyes, as if you were
pulling all your facial muscles to the center of your nose. Pull as
tight as you can and hold it. Feel the tension you have created with
these muscles, especially the forehead and eyes. Now relax and exhale.
Feel the absence of tension in these muscles. They feel loose and
calm. Try to compare this feeling of relaxation with the tension just
produced. Now, contract those same muscles of your face, but this time
at half the intensity, just 50%. Hold it, and relax. Exhale. Feel how
relaxed those muscles are. Compare this feeling to what you just felt
in the last contraction. This comparison should make these muscles are
even more relaxed. Now, finally, contract these same facial muscles at
only 5%. Five percent is a slight contraction. It is like feeling a
slight warm breeze on your forehead and cheeks. Hold it. And relax.
Take a comfortably slow and deep breath and as you exhale feel how
relaxed these muscles of your face are.?
TIA or mini-strokes
?Thrombotic strokes may be preceded by one or more "mini-strokes,"
called transient ischemic attacks, or TIAs. TIAs may last from a few
minutes to a few days and are often a warning sign that a stroke may
occur. Although usually mild and transient, the symptoms caused by a
TIA are similar to those caused by a stroke.
Another type of stroke that occurs in the small blood vessels in the
brain is called a lacunar infarct. The word lacunar comes from the
Latin word meaning "hole" or "cavity." Lacunar infarctions are often
found in people who have diabetes or hypertension (high blood
?What are the most common symptoms of stroke?
The following are the most common symptoms of stroke. However, each
individual may experience symptoms differently. If any of these
symptoms are present, call 911 (or your local ambulance service)
immediately. Treatment is most effective when started immediately.
Symptoms may be sudden and include:
?weakness or numbness of the face, arm, or leg, especially on one side of the body
?confusion or difficulty speaking or understanding
?problems with vision such as dimness or loss of vision in one or both eyes
?dizziness or problems with balance or coordination
?problems with movement or walking
?severe headaches with no other known cause
All of the above warning signs may not occur with each stroke. Do not
ignore any of the warning signs, even if they go away - take action
immediately. The symptoms of stroke may resemble other medical
conditions or problems. Always consult your physician for a
?? Sinusitis causes a feeling of pressure on the face. Sinusitis can
follow a cold or may be caused by hay fever, asthma, or air pollution.
It is more common in adults, but it can occur in children as an
ongoing (chronic) stuffy nose. See an illustration of the facial sinus
? Dental problems, including infections, can cause facial pain and
swelling in and around the jaw area. Jaw pain may be caused by a
temporomandibular (TM) joint problem. This condition can cause pain in
the TM joint (located in front of the ear), in the ear, or above the
ear. For more information, see the topic Mouth Problems, Noninjury.
? Headaches, such as migraines or cluster headaches can cause severe
pain around the eyes, in the temple, or over the forehead. Giant cell
arteritis generally affects older adults and may cause headache and
pain and may lead to blindness if not treated. For more information,
see the topic Headaches.
? Trigeminal neuralgia is a condition that causes abnormal
stimulation of one of the facial nerves. It causes episodes of
shooting facial pain. Closed-angle glaucoma causes vision changes and
severe, aching pain in or behind the eye.
? Conditions that cause problems with the muscles or nerves in the face include:
?Bell's palsy, which is caused by paralysis of the facial nerve. Weak
and sagging muscles on one side of the face is the most common
symptom. It also may cause an inability to close one eye and mild pain
in the facial muscles.
?Multiple sclerosis, which may affect facial muscle control and
strength, vision, and cause changes in feeling or sensation.
?Myasthenia gravis, which causes facial muscle weakness leading to
drooping eyelids and difficulty talking, chewing, swallowing, or
?Muscle Pain and Tightness Muscle pain and tightness around the jaw
(myofascial pain syndrome) come mainly from muscle overuse, often
brought on by problems of misalignment of the upper and lower sets of
teeth, missing teeth, injury to the head or neck, or even toothache.
Pain is also produced by trying to open the jaw too widely. Muscle
pain and tightness can also result from clenching or grinding the
teeth (bruxism) at night due to psychologic or sleep-related stress.
Clenching and grinding while asleep exert far more force than
clenching and grinding while awake.
Internal Joint Derangement In internal joint derangement, the disk
inside the joint lies in front of its normal position. Internal joint
derangement can occur with or without reduction. In internal joint
derangement with reduction, which is the more common type (occurring
in about one third of the adult population), the disk lies in front of
its normal position only when the mouth is closed. As the mouth opens
and the jaw slides forward, the disk slips back into its normal
position. As the mouth closes, the disk slips forward again. In
internal joint derangement without reduction, the disk never slips
back into its normal position, and the degree to which the mouth can
be opened is limited.?
?The disease is characterized by various symptoms and signs of CNS
dysfunction, with remissions and recurring exacerbations. The most
common presenting symptoms are paresthesias in one or more
extremities, in the trunk, or on one side of the face; weakness or
clumsiness of a leg or hand; or visual disturbances, eg, partial
blindness and pain in one eye (retrobulbar optic neuritis), dimness of
vision, or scotomas.?
?Myokymia describes successive, involuntary, small muscle contractions
or tics that affect a bundle of muscles. The muscle movements are
usually visible under the skin and can be felt. Each contraction lasts
for less than one second. Myokymia can affect any muscle group and can
cause digits and eyelids to move. It can also cause stiffness in
hands. Myokymia is not affected by position or movement.
Myokymia is similar to "fasciculations" which are irregular,
flickering, twitching movements that are also caused by involuntary
contractions of muscle bundles. Fasciculations are finer than myokymia
and appear more as rippling movements of the muscles. The difference
between the two is really a medical definition and is best detected by
Other forms of involuntary muscle movements are cramps which are
painful contractions of skeletal muscles and myotonia which is more
persistent than both myokymia and fasciculations.
Myokymia, especially that of the eyelid, is usually a self-resolving
and benign condition. However, myokymia is seen in a number of serious
nervous conditions including multiple sclerosis.
In MS, myokymia in facial muscles (hemifacial spasms) is particularly
common although it can occur in any muscle groups. Myokymia tends to
come and go and is often particularly troublesome when the person is
hot or fatigued.?
?Facial myokymia is a rare presenting feature of a vestibular
schwannoma. We present a 48 year old woman with a large right
vestibular schwannoma, who presented with facial myokymia. It is
postulated that facial myokymia might be due to a defect in the motor
axons of the 7th nerve or due to brain stem compression by the tumor.?
?Background: Myokymia is the spontaneous, fine fascicular contractions
of muscle without muscular atrophy or weakness. Eyelid myokymia
typically involves the orbicularis oculi muscle of one of the lower
eyelids; occasionally, the upper eyelids also can be affected. In most
cases, eyelid myokymia is benign, self-limited, and not associated
with any disease. Intervention is seldom necessary. Rarely, eyelid
myokymia may occur as a precursor of blepharospasm, Meige syndrome,
hemifacial spasm, and spastic-paretic facial contracture.
Pathophysiology: The pathophysiology of typical eyelid myokymia is not
well understood. The focus of irritation is most likely the nerve
fibers within the muscle. However, pontine dysfunction in the region
of the facial nerve nucleus also has been implicated. Possible
precipitating factors include stress, fatigue, and excessive caffeine
or alcohol intake.?
?A unilateral facial muscle paralysis of sudden onset, resulting from
trauma, compression, or infection of the facial nerve and
characterized by muscle weakness and a distorted facial expression.?
?Bell palsy can be defined as an acute, unilateral, lower motor neuron
facial paresis or paralysis, in which no other cause can be
identified. (3) Although it remains the most common cause of facial
nerve paralysis, various intracranial, intratemporal, extratemporal,
skull base, or systemic diseases can also be responsible (table 1).
Although Bell palsy has been defined as idiopathic, there is now good
evidence to implicate the activation of herpes simplex virus near the
geniculate ganglion as the cause of this disorder. (1,6) Cases in
which temporal bone trauma or intratemporal infections cause facial
nerve paralysis can often be correctly identified when the patients
present for examination. In cases of occult intratemporal,
extratemporal, or skull base malignancies, however, patients can also
present with acute facial paresis or paralysis resembling Bell palsy.
Many such patients present to otolaryngologists in a delayed fashion,
which may result in a further delay in diagnosis. We treated 11
patients in wh om occult skull base malignancies had been incorrectly
diagnosed as Bell palsy. We present the clinical manifestations,
evaluation, management, and outcome of these cases.?
?The etiology of Bell palsy remains unclear, although vascular,
infectious, genetic, and immunologic causes have all been proposed.
Patients with other diseases or conditions sometimes develop a
peripheral facial nerve palsy, but these are not classified as Bell
palsy (see Differentials).
? Viral infections: Clinical and epidemiologic data lend credence to
an infectious origin, which triggers an immunologic response,
resulting in damage to the facial nerve. Pathogens leading the list
include herpes simplex virus type 1 (HSV-1); herpes simplex virus type
2 (HSV-2); human herpesvirus (HHV); varicella zoster virus (VZV);
Mycoplasma pneumoniae; Borrelia burgdorferi; influenza B; adenovirus;
coxsackievirus; Ebstein-Barr virus; hepatitis A, B, and C;
cytomegalovirus (CMV); and rubella virus.
? Pregnancy: Bell palsy is uncommon in pregnancy; however, the
prognosis is significantly worse in pregnant women with Bell palsy
than among nonpregnant women with palsy.
? Genetics: Recurrence rates (4.5-15%) and familial incidence (4.1%)
have been addressed in various studies. Genetics may have a role in
Bell palsy, but which factors are inherited is unclear.?
?When a patient with peripheral facial paralysis attempts to close the
eye, there is an upward movement of the eye and the eyelid on the
paralysed side of the face remains open.?
?The herpes simplex virus, lesions of the brainstem and of the angle
between the cerebellum and pons, middle-ear infections, skull
fractures, diseases affecting the parotid gland, and Guillain-Barré
syndrome all may cause facial palsy.
In hemifacial spasm repetitive twitching of one side of the face
occurs. Irritation of the facial nerve as it leaves the brainstem
appears to be the cause, and in many cases relief is obtained through
?The onset of ALS may be so subtle that the symptoms are frequently
overlooked. The earliest symptoms may include twitching, cramping, or
stiffness of muscles; muscle weakness affecting an arm or a leg;
slurred and nasal speech; or difficulty chewing or swallowing. These
general complaints then develop into more obvious weakness or atrophy
that may cause a physician to suspect ALS.
The parts of the body affected by early symptoms of ALS depend on
which muscles in the body are damaged first. In some cases, symptoms
initially affect one of the legs, and patients experience awkwardness
when walking or running or they notice that they are tripping or
stumbling more often. Some patients first see the effects of the
disease on a hand or arm as they experience difficulty with simple
tasks requiring manual dexterity such as buttoning a shirt, writing,
or turning a key in a lock. Other patients notice speech problems.
Regardless of the part of the body first affected by the disease,
muscle weakness and atrophy spread to other parts of the body as the
disease progresses. Patients have increasing problems with moving,
swallowing (dysphagia), and speaking or forming words (dysarthria).
Symptoms of upper motor neuron involvement include tight and stiff
muscles (spasticity) and exaggerated reflexes (hyperreflexia)
including an overactive gag reflex. An abnormal reflex commonly called
Babinski's sign (the large toe extends upward as the sole of the foot
is stimulated in a certain way) also indicates upper motor neuron
damage. Symptoms of lower motor neuron degeneration include muscle
weakness and atrophy, muscle cramps, and fleeting twitches of muscles
that can be seen under the skin (fasciculations).?
Some medications can cause an adverse reaction, causing symptoms such
as you describe. Antibiotics such as Levaquin, Tequin, Cipro, Floxin
can cause reactions, even weeks after taking them.
It would take pages to post everything that feasibly could cause your
symptoms, and this is not a comprehensive list. Again, I urge you to
seek prompt advice from your doctor as soon as possible.
If anything is unclear, please request an Answer Clarification, and
allow me to respond, before your rate. I will be happy to assist you
further with this question, before your rate.
TIAs and facial muscles
outer frontalis muscle
Cranial Nerve 7
Unilateral tightness facial muscles
Unilateral facial muscle drooping
cranial nerves + unilateral forehead tightness
Amyotrophic lateral sclerosis + facial muscles
Upper motor neuron lesion